Clinical Significance of the Reversed Mitral Annular Motion Velocity Wave at the Beginning of the Mitral Valve Closure


Address for correspondence and reprint requests: Yukio Mizuguchi, M.D., Cardiovascular Section, Higashi Tokushima National Hospital, National Hospital Organization, 1-1 Ohmukai-kita, Ohtera, Itano, Itano, Tokushima 779-0193, Japan. Fax: +81-88-672-3809; E-mail:


Background: Pulsed tissue Doppler imaging is increasingly used to record mitral annular motion (MAM) velocity pattern. A reversed MAM velocity wave (Cm) is commonly seen at the beginning of the mitral valve closure in timing, whereas the underlying mechanism and clinical significance have not been studied. Methods: Conventional, pulsed Doppler, pulsed tissue Doppler, and two-dimensional strain echocardiography were performed in 100 consecutive patients with cardiovascular risk factors. Results: There were no correlations between the peak Cm and the ratio of peak early diastolic transmitral flow velocity to peak early diastolic MAM velocity (E/Em) and Tei index. The peak Cm correlated with left ventricular (LV) ejection fraction, left atrial volume index (LAVI) and left atrial ejection fraction, isovolumic relaxation time, peak LV systolic strains and strain rates during atrial systole in the longitudinal and circumferential directions, and peak LV systolic strain rates in the longitudinal, circumferential, and radial directions. Multivariate linear regression analysis revealed that LAVI is a independent predictor related to peak Cm. Conclusion: The Cm is regulated by mitral annular motion velocity toward the LA due to closing of the mitral valve, and may be used as a predictive tool for determining the “disease history” of chronic LV diastolic dysfunction in patients with no marked elevation in the LV filling pressure. (Echocardiography 2010;27:784-790)